Provider Demographics
NPI:1063850683
Name:DESMOND, SHANTELL MARIE (BSHS)
Entity Type:Individual
Prefix:MRS
First Name:SHANTELL
Middle Name:MARIE
Last Name:DESMOND
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DAMONTE RANCH PKWY STE B432
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-1907
Mailing Address - Country:US
Mailing Address - Phone:775-473-5108
Mailing Address - Fax:
Practice Address - Street 1:59 DAMONTE RANCH PKWY STE B432
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-1907
Practice Address - Country:US
Practice Address - Phone:775-473-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NVMI2824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator